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November 07, 2010

What Happens In Toddler Attachment Therapy?

I get asked a lot about what time with a psychologist looks like when the child in the hot seat is pre-verbal. Before we got into weekly visits with a psychologist for Miles, I wondered the same thing. I think that in America, our notion of "therapy" involves laying on a couch while you spill your guts. For Miles, all I could envision was our little guy jumping up and down on said couch Tom Cruise style. But what we do during attachment therapy is SO different that just talking. The therapist and I do a lot of talking. I go over my concerns about Miles behavior and his lack of attachment, and other relevant events that occurred over the past week. If there is something acute going on, we try to trace back the behavior to a trigger. Sometimes just pinpointing trauma triggers for Miles is huge in trying to avoid them in the future. But sometimes, trauma triggers can't be avoided and we discuss strategies for minimizing Miles distress during these times.

For instance, Miles still has major issues concerning food. That memory of hunger just does not seem to go away for him. He will try to take your head off if you take a french fry off of his plate. For him, it is not just an aversion to sharing, but it is a deep seeded fear that there will not be more food after this meal is over. It's not selfishly rooted, it's fear based. When he's at home, the others just know that we don't mess with Miles' food. But in social situations, part of being a toddler is snatching things from each other- and that includes snacks. This week we worked on communal eating. We all tried to eat a snack out of the same bowl. We turned it into a game. We passed a bowl around and everyone got to take a snack out. When the bowl got to Miles, he tried to run away with it. I gave Miles the words that he needed and couldn't say. I would say something like, "I know that you want to take all of these goldfish. But don't be scared. It is okay to share our food. There will be enough for everyone! Let's take one and pass it to the next person." Then we model the behavior that we desire and praise him like crazy when he does it. The hope here is that even though Miles still has fear surrounding food, the more we practice behaviors like these, the more this can be scripted into his brain that it is okay to share.

One of the things that we do a lot of in attachment therapy is play. Many times we play games in which the therapist and I manipulate situations. For instance:

One of our favorite games to do is play a game where the therapist and I sit on opposite sides of the room. She will have Miles run to me. I play it up and encourage him like crazy. When he gets to me, he is supposed to kiss or hug me. Keep in mind- kissing and hugging are intense for Miles. In the beginning, when he would run to me, he would turn around backwards and have me hug him from behind because hugging face to face was just too much for him. Then I send him back to the therapist. When he gets to her, they high five or fist bump or some other less intense contact. All of this is designed to teach him to differentiate the level of contact that we have with family and the level of contact with have with acquaintances. This is one of the ways in which I can see the most improvement with Miles. In the first weeks with our therapist, he would barely get out of her lap. He wanted nothing to do with me. He would barely even make eye contact with me. She was constantly trying to redirect his attention to me, but he was reluctant to leave her. Now, Miles is spending equal time clinging to each of us during our therapy sessions. That is a huge improvement. Remember, many times for our children who come from hurt places, they are more comfortable with transient relationships because you can't get emotionally hurt when a transient person leaves you. Flocking toward the transient relationship is a self preservation technique. Having a professional involved in doing this kind of therapy is so essential for a couple of reasons: 1) a professional knows how to not feed into a child with attachment/trauma related manipulation tactics and 2) they can resist the cuteness of a child wanting to cuddle up in their lap and redirect to the parent! It is hard for the average person to resist a little child wanting you to hug and cuddle them. But in teaching our children to differentiate appropriate contact with family and outside contacts and instill the need to avoid strangers, this is essential.

We also play games where Miles gets rewarded for seeking me out. He and the therapist will tip toe around the house "looking" for me and when they find me I am very animated and tickle and roll around on the floor with Miles. Again, this is designed to teach him that he can seek me out when he needs me and that he will be rewarded for relying on me.

Having a professional around to bounce ideas off of is a very valuable resource for parents. Many times disciplining and teaching our adopted children is different that parenting our biological children. Miles just learned the word "tickle" a few weeks ago. But his idea of where he can tickle people is often very inappropriate. In these situations, I would just pick him up and remove him from the inappropriate tickle fest. But in talking with the therapist, we now have better strategies. Tickling is an important part of development and in teaching good touch for toddlers. Me taking that away from him was not the right thing to do. The therapist worked with us in teaching him the "right" way to tickle the other kids. Again, so much of attachment therapy and overcoming trauma is modeling and reward the appropriate and desired behavior. Now when tickling starts, we direct it. I'll shout out, "Now let tickle each other's arms!" or, "Time to tickle each other's necks!" By guiding and directing the behavior, we've eliminated the bad behavior and are reinforcing what "good touch" is for our son. And just FYI- we've had a very loooong talk with the big kids about good and bad touch and what they need to watch for and things that they need to tell mommy and daddy about right away. Capiche?!

When we have the siblings around, we create little "plays" for them. We will ask Noah to pretend that he is hurt. The sibs love doing this kind of dramatic work. When they are successfully lying on the floor in their state of "fake hurt" I will take Miles with me and show him how mommy can come in and hold and kiss and make the situation better. This helps Miles to learn empathy as well as that mommy is our friend when we're hurt. Miles is still not there yet with this one. We he gets hurts he still prefers to writhe around on the floor and go into wounded animal mode ready to fight anyone who gets close to him. But he's learning. I've seen him model the appropriate behavior with his baby dolls. He gets the concept, but for right now, equating it to his real life still makes him feel too vulnerable. He's getting there, though.

We also do a whole lot of therapy flashcards. We've done flashcards in speech therapy for a long time. But now we've carried over that concept into our attachment therapy. We took very staged pictures like this:

On the backs of these flashcards, we write very simple sentences that we say over and over again as we go over each photo. For example, on the top photo where Sadie is pretending that her arm is hurt, we say, "Mommy makes it better." For the bottom photo, we say, "Mommy kisses Miles." We also have photos of me kissing and hugging each of the children and the same things with pictures of Kamron. We also took pictures of me hugging Kamron and us kissing each other. These flashcards are putting into Miles ingrained memory and vocabulary what the roles of mommy's and daddy's are. Getting those phrases and an image of the loving touch and loving relationships is essential to him figuring out that we are the people who are supposed to take car of things for him. Our hope is that as he is able to learn to differentiate his needs and that one day if he decides he needs a hug, he will have drilled into his brain, "Oh yeah! Mommy hugs Miles. Mommy kisses Miles!" and he will come to me to have his needs fulfilled.

These things may all sound ridiculous to a person who has never dealt with an attachment challenged child. Keep in mind though, that spending any time institutionalized without a family structure means that children have not learned what it looks like to be in a family and therefore must be taught those skills. We take for granted with our biological children that they just naturally have always had the security that comes with having a family from day one.

I realize that we are insanely lucky to have an attachment therapist. (and an occupational therapist and a speech therapist and a developmental therapist and a PT consult.) To live in such a backwards state, Kentucky truly does have one of the most progressive early intervention programs in the US. We are able to get all of these resources for the rock bottom total price of $40 a month- TOTAL-for all 20 hours of private therapy that Miles receives every month. I'm not saying that to gloat, but to say that I recognize that not everyone has access to these kinds of resources. That is why I decided to share what we are doing and the practical activities that we do every single day to help our son get where he needs to be. The things that we are doing can easily be done in anyone's home. Recruit a neighbor to help you be the transient person in your role playing games who helps to always redirect the child to the parent. I hope that this may help some of you out there who don't qualify for resources. If you aren't sure if your state has early intervention resources, you can look up your state's contact person here: http://www.nectac.org/contact/ptccoord.asp

And most of all- remember (and this is OH SO HARD!) not to take attachment disorders personally. This does not happen because you are a bad parent or because your child just "doesn't like you." Remind yourself when you are in the trench that this is a result of the hurt done to your child. Don't blame yourself. Don't blame your child. Reminding myself of that (sometimes dozens of times a day) really helps me difuse the situation, calm down my hurt feelings, and be more understanding to my child who more than anything just needs my understanding.

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